| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
955 |
357 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,144 |
2,131 |
$61K |
| D1120 |
Prophylaxis - child |
1,482 |
1,468 |
$53K |
| D1110 |
Prophylaxis - adult |
679 |
675 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,311 |
2,292 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
219 |
213 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,546 |
1,844 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,976 |
1,948 |
$24K |
| D0272 |
Bitewings - two radiographic images |
967 |
958 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
240 |
$17K |
| D0274 |
Bitewings - four radiographic images |
430 |
430 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
411 |
376 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
23 |
$808.83 |
| D0602 |
|
2,520 |
2,505 |
$0.00 |
| D0601 |
|
88 |
86 |
$0.00 |